Circ Arrhythm Electrophysiol

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Circ Arrhythm Electrophysiol Prevalence, Characteristics, Mapping, and Catheter Ablation of Potential Rotors in Nonparoxysmal Atrial FibrillationClinical Perspective by Yenn-Jiang Lin, Men-Tzung Lo, Chen Lin, Shih-Lin Chang, Li-Wei Lo, Yu-Feng Hu, Wan-Hsin Hsieh, Hung-Yu Chang, Wen-Yu Lin, Fa-Po Chung, Jo-Nan Liao, Yun-Yu Chen, Dicky Hanafy, Norden E. Huang, and Shih-Ann Chen Circ Arrhythm Electrophysiol Volume 6(5):851-858 October 15, 2013 Copyright © American Heart Association, Inc. All rights reserved.

Illustration of the substrate mapping after the pulmonary vein isolation (PVI). Illustration of the substrate mapping after the pulmonary vein isolation (PVI). A, The degree of the complex fractionated atrial electrograms (CFAEs) was indicated by the level of the mean-FI. Area with a mean FI of <120 ms was considered important (nonblue areas) and a signal analysis was applied using the DF analysis (DF>7 Hz, blue area), and similarity index (SI>0.5, blue area). B, The areas with a high DF and high SI overlapped and were located adjacent to the maximal CFAEs, where discrete electrograms were identified, and point-by-point activation maps revealed a small-radius-reentry as a rotor. Panel C shows representative examples of the electrograms inside the rotor, maximal CFAE near the rotors, maximal CFAE outside the rotors, and non-CFAEs. The signal characteristics from A to E in panel A are illustrated in panel C. LIPV indicates left inferior pulmonary vein; LSPV, left superior pulmonary vein; RAO, right anterolateral view; RIPV, right inferior pulmonary vein; and RSPV, right superior pulmonary vein. Yenn-Jiang Lin et al. Circ Arrhythm Electrophysiol. 2013;6:851-858 Copyright © American Heart Association, Inc. All rights reserved.

Catheter ablation results of the pulmonary vein isolation (PVI) and substrate modification in all patients. Catheter ablation results of the pulmonary vein isolation (PVI) and substrate modification in all patients. AF indicates atrial fibrillation. Yenn-Jiang Lin et al. Circ Arrhythm Electrophysiol. 2013;6:851-858 Copyright © American Heart Association, Inc. All rights reserved.

A, The complex fractionated atrial electrograms (CFAEs) in 1 persistent patient with atrial fibrillation after pulmonary vein isolation. A, The complex fractionated atrial electrograms (CFAEs) in 1 persistent patient with atrial fibrillation after pulmonary vein isolation. The white area indicates the continuous CFAEs. B, An activation map showing a small-radius re-entry circuit over the left atrial anterior wall with a distance of 1.0 cm to the left pulmonary vein. C, Fibrillatory electrograms of the rotors showing a narrow-peak and higher dominant frequency (DF), higher consistency between intervals, and higher degree of a beat-to-beat similarity than the atrial substrate compared with the rotor-free areas. SI indicates similarity index. Yenn-Jiang Lin et al. Circ Arrhythm Electrophysiol. 2013;6:851-858 Copyright © American Heart Association, Inc. All rights reserved.

The receiver operating characteristic curve analysis of the generalized estimating equation displayed the optimal threshold and goodness of fit for the (A) dominant frequency (DF), (B) kurtosis, (C) similarity index (SI), and (D) combined model of the DF, kurtosis, and 10-fold SI. AUC indicates area under the curve; and CI, confidence interval. The receiver operating characteristic curve analysis of the generalized estimating equation displayed the optimal threshold and goodness of fit for the (A) dominant frequency (DF), (B) kurtosis, (C) similarity index (SI), and (D) combined model of the DF, kurtosis, and 10-fold SI. AUC indicates area under the curve; and CI, confidence interval. Yenn-Jiang Lin et al. Circ Arrhythm Electrophysiol. 2013;6:851-858 Copyright © American Heart Association, Inc. All rights reserved.

Kaplan–Meier curves demonstrating the freedom of atrial arrhythmia recurrence after a single (A) and multiple procedures (B). Kaplan–Meier curves demonstrating the freedom of atrial arrhythmia recurrence after a single (A) and multiple procedures (B). AF indicates atrial fibrillation; and PVI, pulmonary vein isolation. Yenn-Jiang Lin et al. Circ Arrhythm Electrophysiol. 2013;6:851-858 Copyright © American Heart Association, Inc. All rights reserved.